TEACHING STRATEGY

1. TEACHING STRATEGY Demonstration and Return-Demonstration Karen Micale, RN, BSN, NCSN

2. DEFINITION • Demonstration • shows the learner how to perform a skill by the teacher (Bastable, 2008) • Return-Demonstration • Carried out by the learner to perform a task with cues from the teacher (Bastable, 2008)

3. Why demonstration? • “A demonstration provides a concrete, realistic learning experience. It has the advantage of using visual as well as oral perceptions. Other senses may be used such as smell or touch. The emphasis is on what to do, rather than on what not to do.” (Cooper, S., 1982) • “Ensures that learning and comprehension have occurred. This method can increase the opportunity for the learner to understand and apply the skill that is taught. Verbalizing what they are doing, in their own words, will also increase the likelihood of patients’ retention.” (Burkhart, J.A., 2008)

4. DESCRIPTION • Models- • Replicas: constructed to scale: • models of the heart, kidney, DNA helix, resuscitation dolls, breast models • Analogues: has the same properties and performs like the real object: • Dialysis machines, computer model of the brain • Symbols: used in teaching situations: • Traffic signals, words, mathematical signs, stick figures, international signs. (Bastable, 2008)

5. Domains of Learning • Primarily effective in teaching psychomotor skills • Examples: teaching self-injections, breast self-exams, testicular exams using anatomical models • May enhance cognitive and affective learning • Examples: assisting developing interactive skills for crisis intervention, grief counseling, interviewing, history taking (Bastable, 2008).

6. Cognitive Learning Theory by Robert Gagne • Reception-gain learner’s attention • Expectancy-inform learner of objectives • Retrieval-stimulate learner’s recall of prior learning • Selective- perception • Semantic encoding-facilitate learner’s understanding • Responding-learner demonstrates the new skill or information • Reinforcement-give feedback to the learner • Retrieval-assess the learner’s performance • Generalization-enhance retention and transfer through application and varied practice. (Bastable, 2008, p. 62-63)

7. Uses of Demonstration and Return Demonstration • CPR • Insulin self-injections • Dressing changes • Self-catheterization • Glucose monitoring • Testicular/Breast exams on models • Preparing medications • How to use an asthma inhaler • Tube Feedings • Colostomy irrigation • Epi-pen self-injections • Monitoring blood pressures • Taking patient histories • Crisis intervention skills

8. Appropriate Settings • Inpatient • Outpatient, clinics, doctor’s offices • Community centers, Senior centers, Wellness centers • Classroom and other academic settings • One-on-one • Nursing schools, medical schools

9. Advantages • Especially effective for learning in the psychomotor domain • Actively engages the learner through stimulation of visual, auditory, and tactile senses • Repetition of movement and constant reinforcement increases confidence, competence, and skill retention • Provides opportunity for over-learning to achieve the goal (Bastable, 2008). • Increased ability to control the environment and simulate clinical practice (Billings, D.M.& Halstead, J.A., p. 309, 2009) • Effective teaching method for low literacy, can increasing health literacy

10. Disadvantages • Requires plenty of time for teaching as well as learning • Audience size must be kept small to ensure opportunity for practice and close supervision • Equipment can be expensive to purchase and replace • Extra space and equipment is needed for practicing certain skills • Competency evaluation requires 1:1 teacher-student ratio. (Bastable, 2008)

11. Methods of Adaptation • Encourage students to learn at their own rate • Adjust teaching time to meet individual needs • Accommodate a variety of learning modes: visual, auditory, kinesthetic, tactile • Address any cultural needs • Be aware of any learning disabilities • Provide more time for elderly patients to practice

12. Evaluation • Evaluation of learning and retention is a complex task. • Learning is defined as a change in cognitive, psychomotor and/or affective behavior.” • Activities used for teaching are only effective to the extent that they result in a change in one or more of the 3 learning domains. (Dougal, J., Gonterman, R., 1999)

13. Methods of Evaluation • Formative: • Can my teaching be improved to enhance learning? • Am I giving the learner enough time to practice? • Is the demonstration material appropriate for the learning objectives • Do I need more opportunities for return demonstration?

14. Methods of Evaluation • Summative: • Was the overall goal accomplished? • Were the behavioral objectives met? • Was the level of competency increased? • Was the skill learned-is the patient able to perform return-demonstration with 100% accuracy? • Likert scales, questionnaires, pre-test and post-test comparisons, Return demonstration checklists (performs independently, performs with minimum verbal clues, unable to perform)

15. References Bastable, S.B. (2008). Nurse as educator: Principles of teaching andlearning. 3rd Ed. Boston: Jones & Bartlett. Burkhart, J.A. (2008). Training nurses to be teachers. The Journal of Continuing Education in Nursing. 39, 503-510. Billings, D., & Halstead, J. (2009), Teaching in nursing; A guide for faculty. St. Louis: Saunders Elsevier. Cooper, S. (1982) Methods of teaching-revisited the demonstration. The Journal of Continuing Education in Nursing, 3, p. 44-45. Dougal, J., Gonterman, R. (1999) A comparison of three teaching methods on learning and retention. Journal for Nurses in StaffDevelopment, vol. 15, 5, 205-209.